BladderPath: Can mpMRI Expedite Treatment for Muscle-Invasive Bladder Cancer?

Although transurethral resection of bladder tumor (TURBT) is used as the initial staging procedure for new diagnoses of bladder cancer, the procedure may delay definitive treatment for patients with muscle-invasive bladder cancer (MIBC).

Results from the prospective BladderPath trial have provided new insight into whether definitive treatment can be expedited for MIBC through the use of flexible cystoscopic biopsy and multiparametric magnetic resonance imaging (mpMRI) for initial staging over TURBT.

In this open-label randomized study, investigators screened 638 patients from 17 hospitals based in the United Kingdom between May 2018 and December 2021. Patients with suspected new BC were randomized 1:1 to undergo either TURBT-staged or mpMRI-staged care, with minimization factors of sex, age, and clinician visual assessment of stage.

Blinding was not possible during the study, and patients with previous BC or those unable or unwilling to undergo mpMRI were ineligible. The study had two stages with separate primary outcomes of feasibility and time to correct treatment (TTCT) for MIBC.

A total of 143 patients were assigned to TURBT (n=72; 55 males, 15 MIBCs) or initial mpMRI (n=71; 53 males, 14 MIBCs). For feasibility, 36 of 39 (92% [95% CI, 79%-98%]) patients with suspected MIBC underwent mpMRI.

The median TTCT for patients with MIBC was significantly shorter with initial mpMRI (n=12, 53 days [95% CI, 20-89] vs n=14, 98 days [95% CI, 72-125] for TURBT, P=.02). No detriment was found for patients with non-MIBC (median TTCT: n=30, 17 days [95% CI, 8-25] for mpMRI vs n=28, 14 days [95% CI, 10-29] for TURBT, P=.67), and no serious adverse events were reported.

The use of mpMRI for patients with MIBC led to a 45-day reduction in TTCT. Using mpMRI before TURBT may be beneficial for patients with suspected MIBC.